Vascular Connections The Official Newspaper of the Vascular Annual Meeting
PREVIEW EDITION
SOCIETY FOR VASCULAR SURGERY • JUNE 20–JULY 2, 2020 • SVS ONLINE
Crawford Critical Issues Forum 2020 echoes founding charge: ‘Defining and valuing vascular surgery in the coming decade’ By Bryan Kay This year’s E. Stanley Crawford Critical Issues Forum is set to come full circle from its very genesis 32 years ago at the Vascular Annual Meeting (VAM) in Chicago.
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ow a lynchpin of the Society for Vascular Surgery (SVS) flagship event on its opening day, this year not only will it make an unlikely return to the original Saturday slot it occupied in 1988 but also to the spirit of the fundamental themes outlined by E. Stanley Crawford, MD, then the outgoing SVS president, when he called for the forum’s introduction. As per tradition, the session is the brainchild of the incoming SVS president. This year's rendering of the forum, entitled “Defining and valuing vascular surgery in the coming decade,” covers vascular surgery branding, the value of the specialty to the healthcare system, an SVS Wellness Task Force pulse check, and insight on how U.S. healthcare rankings are compiled by U.S. News & World Report. President-elect Ronald L. Dalman, MD, saw the founding charge set out by his forbear reverberating down the years. “The original impetus for the meeting was to affirm the leadership of the SVS in the development of vascular surgical science and help the society to navigate the challenges of the times, separate from the more scientific presentations: The question that was posed by E. Stanley Crawford
week in contrast to more recent times when the conference begins on a Wednesday: “So it being on a Saturday this year, we have come full circle on that.” That extends to the theme. Dalman considers the varying topics that have constituted the forum over the years. Some have been clinical, while more recently and commonly they have tended toward some of the more macro level challenges to vascular surgery practice. It’s at this juncture Dalman slots in, picking up the baton left first by Michel S. Makaroun, MD, SVS president from 2018–19, and Kim Hodgson, MD, the incumbent president. While the former focused on the perils of a coming shortage in vascular surgeons, Hodgson zeroed in on appropriateness in care. Which brings things neatly back to the baseline set by Crawford three decades ago. In June 1996, Calvin B. Ernst, MD, penned an article in the Journal of Vascular Surgery that recalled the opening years of the Crawford forum’s journey.
was, ‘Who would want to go into vascular surgery today with the uncertainties of tomorrow and how can those who are already committed remain dominant?’” the president-elect tells Vascular Connections. “That’s the founding charge.” VAM 2020, of course, has been replaced by the alternative virtual conference SVS ONLINE owing to the novel coronavirus. As Dalman notes, VAM traditionally was held at the beginning of the
By Bryan Kay Extracellular vesicles enhance deep vein thrombosis (DVT) via receptor interacting protein kinase-3 (RIPK3), the study that claimed this year’s SVS Foundation Resident Research Award found, raising the suggestion of a causal relationship between necroptosis and hypercoagulative states seen in various diseases.
“It’s ironic if you read this article, many of those same issues and questions were being addressed more than 30 years ago,” says Dalman. “They’ve evolved, they’ve expanded, they’ve taken on different levels of urgency. But the fundamental questions are still there. I think that’s how we came up with the program for this year’s Crawford Critical Issues Forum.” The first presentation on the Crawford slate sees an update on the
MITRI KHOURY, MD, a general surgery resident at the University of Texas Southwestern in Dallas, will present the findings during the William J. von Liebig Forum—the opening scientific session—on the first day of SVS ONLINE. Khoury and a team of colleagues had sought to establish how RIPK3 is carried in plasma and whether its presence can enhance thrombus formation. “Receptor interacting protein kinase 3 (RIPK3) is a key mediator of a regulated form of cell death termed necroptosis,” they state. “Recent studies have demonstrated elevated levels of RIPK3 within the plasma of patients with hypercoagulative states. In addition, other mediators of necroptosis have been found to be associated with thrombus formation.” The fruit of several different projects
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GENESIS
President-elect Ronald Dalman
Resident Research Award-winning paper: Extracellular vesicles enhance DVT via RIPK3
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Crawford Critical Issues Forum 2020 echoes founding charge: ‘Defining and valuing vascular surgery in the coming decade’ Continued from page 1
SVS Branding Initiative Task Force, question is: What toll does that take covering the work the Society has on vascular surgeons?” carried out with Springboard Brand The third podium talk in the & Creative Strategy to thrash out forum—“Maintaining vascular how vascular surgeons fit in to the capability in troubled times: Update American health system, what the from the SVS Wellness Task role of the vascular specialist should Force”—deals with this question. be and how they can differentiate “To get back to Dr. Crawford’s themselves from other specialties original message—who would want with occasionally overlapping to go into vascular surgery? Well interests, explains Dalman. “The certainly if everybody is depressed Branding Initiative Task Force and overworked nobody would is going to help us understand want to go into vascular surgery.” and position vascular surgery in The final presentation such a way that our colleagues in underscores Dalman’s vision for the health system, and leaders in this year’s Crawford forum. It will American healthcare who might be given by Benjamin Harder, not be physicians themselves, can managing editor and chief of health understand what it is we do exactly.” analysis at U.S. News & World Report. Next up is a talk entitled, Harder is involved in putting “Value of the vascular surgeon to together the influential healthcare the healthcare system,” rankings published which drills into the by the publication. Vascular Valuation Study, “One of the a collaboration with challenges for our healthcare intelligence members in the U.S. services company Sg2 to at the current time complete an assessment is the U.S. News & and consulting report on World Report rankings the valuation of vascular do not recognize surgery services. vascular surgery as As Dalman describes, a separate specialty,” the purpose of this talk is says Dalman. “I would to pose fundamental questions: JVS article say, being as objective “What is the value of a vascular featuring as I can, vascular surgery Crawford surgeon to our healthcare is one of the largest system, to our community, to and most influential our region to the nation, aside from specialties that is not recognized as a the patients that we have primary separate specialty.” responsibility for, what value add There is a narrative flow to do we provide to the care of the this year’s forum. The running population as whole?” order was no mere accident. Dalman was very deliberate in its SURGEON WELLNESS constitution. His guiding rationale The specter of vascular surgeon was to construct the thread of burnout has moved up the agenda presentations in such a way as in recent years. It was into this new Harder would absorb the preceding atmosphere the SVS Wellness Task talks before himself taking to the Force emerged. podium. His assigned talk captures It occupies an important place in the essence of Dalman’s thinking: the vascular firmament. “One of “Public reporting of vascular my colleagues, Larry Kraiss, MD, surgery quality by U.S. News & at the University of Utah, told me World Report: Why, how and what's that they had looked at their clinical ahead.” volume and determined that about Explains Dalman: “I’m hoping 40% of their patients did not come his takeaway, before he gives from their clinic, which means they his presentation, is that vascular came through the emergency room surgery is a substantial player in the or transfer request, consultation in American healthcare system and the operating room for bleeding deserves this type of recognition.” or some other technical challenge another specialty may be facing ... When: Saturday, June 20, 2020, That’s fine, that’s our role. But the 12:45 p.m.–2 p.m. Crawford Forum
JUNE 2020 | PREVIEW EDITION
SVS ONLINE: New Advances and Discoveries in Vascular Surgery Schedule at a Glance Educational Sessions All times are CDT Monday 6/15/2020 2:00-3:00 PM Annual Business Meeting: Session 1 Saturday 6/20/2020 11:00-11:30 AM
Presidential Welcome
11:30 AM-12:45 PM
Scientific Session: William J. von Liebig Forum
12:45-2:00 PM
E. Stanley Crawford Critical Issues Forum: Defining and Valuing Vascular Surgery in the Coming Decade
2:00-3:00 PM
Annual Business Meeting: Session 2
Tuesday 6/23/2020 6:00-6:30 PM
Roy Greenberg Distinguished Lecture: Alan Lumsden, MD, TeleWhat? Beyond the Office: How Remote Support Systems Will Transform Education, Case Support and Care Delivery
6:30-7:30 PM
Scientific Session: Venous Disease
7:30-8:30 PM
Education Session: American Venous Forum Debates 2020: Are DVT & PE Interventions Unnecessary?
Wednesday 6/24/2020 1:00-4:00 PM
VESS Program
Thursday 6/25/2020 Session 1 1:00-2:00 PM
Scientific Session: Aortic Disease
2:00-3:00 PM
Education Session: Digital Health Advancements in Vascular Surgery
Session 2 6:00-7:00 PM
Scientific Session: Peripheral Artery Disease (PAD)
7:00-8:00 PM
Education Session: Current Controversies in Endovascular Therapy for PAD
Saturday 6/27/2020 9:00-10:00 AM
Scientific Session: Dialysis Access
10:00-11:00 AM
Education Session: Challenges and Controversies in Hemodialysis Access
Tuesday 6/30/2020 6:00-6:30 PM
International Lecture: Juan Parodi, MD, International Lifetime Achievement Awardee
6:30-7:30 PM
Scientific Session: Aortic Disease
7:30-8:30 PM
Education Session: Management of Type II Endoleaks
Wednesday 7/1/2020 6:00-7:00 PM
Scientific Session: Cerebrovascular
7:00-8:00 PM
Education Session: Enhancing Wellness in Times of Chaos
Thursday 7/2/2020 Session 1 1:00-2:00 PM
Scientific Session: Peripheral Artery Disease (PAD)
2:00-3:00 PM
Education Session: Spine Exposure for the Vascular Surgeon
Session 2 6:00-7:30 PM
Scientific Session: General, including Late-Breaking Abstracts
7:30-9:00 PM
Forum: Assuring Quality in Vascular Surgical Care: The Future of Center, Program and Surgeon Accreditation
9:00-9:15 PM
Closing Remarks
Industry Sessions (not eligible for CME credits) Tuesday 6/23/2020 8:30-9:00 PM
Industry Sponsored Session 1
Thursday 6/25/2020 Session 1 3:00-3:30 PM
Industry Sponsored Session 2, sponsored by Medtronic
Session 2 8:00-8:30 PM
Industry Sponsored Session 3, sponsored by Gore & Associates
Session 3 8:30-9:00 PM
Industry Sponsored Session 4, sponsored by Janssen Pharmaceuticals, Inc.
Saturday 6/27/2020 Session 1 11:00-11:30 AM
Industry Sponsored Session 5
Session 2 11:30 AM-12:00 PM
Industry Sponsored Session 6
Tuesday 6/30/2020 8:30-9:00 PM
Industry Sponsored Session 7
Wednesday 7/1/2020 Session 1 8:00-8:30 PM
Industry Sponsored Session 8, sponsored by Silk Road Medical
JUNE 2020 | vascularspecialistonline.com
Vascular Connections | 3
Carving out virtual alternative to VAM in throes COVID-19 By Bryan Kay As Society for Vascular Surgery (SVS) Postgraduate Education Committee chair Vikram Kashyap, MD, tells it, the organizers behind programming for the Vascular Annual Meeting (VAM) had never before been confronted with such a mammoth task.
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ike it did in all but a handful of areas of public life, the novel coronavirus landed like a wrecking ball on the vascular conference circuit, and VAM, the flagship event on the SVS calendar, had become yet another victim. That sparked an almighty pivot, Kashyap explains—a brisk turnaround that birthed a virtual replacement for this year’s iteration of the annual event: SVS ONLINE, or Optimizing Novel Learning In A New Environment, which kicks off June 20 for a two-week run. For Kashyap, this meant getting to work with some haste in order to re-tool the elements of the event organized by the Postgraduate Education Committee. It’s a process of which the chief in the division of vascular surgery and endovascular therapy at University Hospitals Cleveland Medical Center in Cleveland and his committee members are proud.
“This has probably been the largest pivot in SVS history for the annual meeting, taking a completely live program and turning it into a series of live webinars,” Kashyap tells Vascular Connections. The portion organized by Kashyap and the Postgraduate Education Committee required some work (Program Committee chair Matthew Eagleton elaborates, below). “We had a spectacular number of invited sessions slated for the VAM this year: six three-hour postgraduate course, six 90-minute breakfast sessions; ask-the-experts, small-group sessions that were to be one-hour interactive sessions where you would find out tips and tricks, how to do certain types of cases, and how to take care of certain types of patients,” Kashyap explains. “And then, at the time we were formulating VAM, we had seven—it was going to expand likely to eight— concurrent programs 90 minutes in
How VAM became SVS ONLINE By Beth Bales How do you turn a live event for thousands of participants and exhibitors into a trimmed-down, online experience? CAREFULLY, AND NOT EASILY. “We got here because COVID-19 happened,” wryly observed Matthew Eagleton, MD, chair of the Society for Vascular Surgery (SVS) Program Committee, shortly after planners and staff completed most of the new schedule for the trimmed-down, online experience. In fact, it will be an SVS ONLINE experience—a platform which the SVS will use going forward for other virtual learning sessions. “Almost a year of planning goes into the Vascular Annual Meeting,” he said. And now, instead of gathering in June in Toronto, members and participants will instead gather in front of their computers, tablets or phones to participate in a portion of the originally scheduled events. The traditional VAM includes four days of
length, highlighting things as disparate as telemedicine, leadership and different clinical aspects of taking care of vascular patients. All of that was ready to go before COVID changed everyone’s plans.” For SVS ONLINE, that line-up has been pared back to include seven broad topic areas that can be covered in an hour. Each session will see three to four experts conduct around 30 minutes of pre-recorded didactics followed by 15 minutes each of both
Vikram Kashyap
Matthew Eagleton
panel discussion and an online Q&A. “What we did was solicit feedback from our members, and, quite frankly, a lot from our committee members as to what would be compelling material for a virtual format,” says Kashyap. The guiding rationale zeroed in on ensuring members would be properly engaged and that the topics would lead to quality discussion within the virtual sphere. The seven sessions cover the management of type II endoleaks; digital health
programming, from postgraduate courses, to breakfast sessions, podium sessions outlining the latest research, other educational sessions, industrysponsored presentations, an exhibit hall and a whole host more. In contrast, SVS ONLINE: “New Advances and Discoveries in Vascular Surgery,” will include multiple sessions, from two to four hours, on nine separate days. SVS ONLINE will open Saturday, June 20, and wind up on Thursday, July 2 (see page 2 for schedule). Included will be both live events that include pre-recorded presentations but live discussions; and strictly on-demand programming. “This is not a replacement for VAM, but an alternative for VAM,” said Eagleton. “It’s just been a flurry of activity,” he said of the past few months. “We considered everything: what can we possibly include, what do we want to present as representative of what VAM has to offer; the timing – when can people make it, WILL people make it?” A whopping 97% of the abstract-based presentations have agreed to be part of SVS ONLINE. SVS’ longtime VAM partner, the Vascular and Endovascular Surgery Society (VESS) also will hold one of its abstract-based sessions online. Selecting and optimizing the number of invited sessions was a huge effort, Eagleton said. Many programs had to be eliminated (or deferred until 2021) and those selected had to be trimmed. “In some cases, the PGEC converted programs that
advancements in vascular surgery; current controversies in endovascular therapy for peripheral arterial disease (PAD); a debate around whether aggressive clot debulking is needed for deep vein thrombosis/submassive pulmonary embolisms; spine exposure for the vascular surgeon; enhancing wellness in times of chaos; and challenges and controversies in hemodialysis access. Kashyap is cognizant of the paradigm shift the move to a virtual event represents. “SVS ONLINE is a necessary substitute for the live VAM experience. We completely understand we cannot replicate the live experience but we’re trying to bring education, science, and important, relevant and timely information to our members as quickly as we can—and do it in a way that hopefully engages our membership, understanding that many will have other commitments.” That said, Kashyap accentuates the opportunities SVS ONLINE presents. “We’ve got great science from the abstracts, we’ve got great invited speakers, and we’re going to engage our industry partners to also provide non-CME [continuing medical education] content,” he says. “And, we may find out that the SVS ONLINE platform can be incorporated into future SVS educational programs.”
were three hours long to one: 30 minutes of presentation and 30 minutes of discussion. The committee did a phenomenal job, as did the SVS staff.” A major effort went into preserving the science, he added. Many clinical topics remain relevant from year to year, but science has a much shorter shelflife, he said. “It was extraordinarily important for our researchers to be recognized, to get a chance to present and for them to get academic credit for the work they’ve done.” Determining timing was also a challenge, with organizers worried that stretching the meeting out over six or seven weeks would result in losing the audience. Presenting meetings online went from something no one was doing to an “extraordinarily crowded space. So we shortened the time frame.” Other considerations were days of the week and times of day. “It will be interesting from an operational point of view to see how it goes,” he said of the schedule, which includes weekdays, Saturdays, mid-day time frames and evenings. Online is probably the way of the future, Eagleton added. “It will certainly revolutionize how we treat meetings going forward,” he said. “I don’t think the traditional meeting will ever happen in the same way. Perhaps going forward, we will do a mix of live and online.”
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JUNE 2020 | PREVIEW EDITION
Resident Research Award: Extracellular vesicles enhance DVT via RIPK3 Continued from page 1
tackled by Khoury et al in the lab, the study also grew out of his professional curiosity in venous thrombosis, he tells Vascular Connections. “The project first started when initially we observed this finding that RIPK3 enhances thrombin generation,” he elaborates. “I’ve always had an interest in looking at venous thrombosis. When we noticed this phenomenon, we decided to explore its role in deep vein thrombosis.” The work was carried out while Khoury was carrying out a National Institutes of Health (NIH)funded T32 vascular research fellowship at the University of Wisconsin, Madison. His mentor on the study, Bo Liu, MD, professor of surgery at the University of Wisconsin School of Medicine and Public Health in Madison, highlighted potential new ground broken by Khoury and his colleagues. “When Mitri joined the lab, he took my interest in cell death, his interest in thrombosis and the graduate students’ interest in extracellular vesicles, put them all together, and came up with the hypothesis and, after many months of hard work, with the findings. “So, in a sense it’s novel interdisciplinary research. What is most striking for me is that RIPK3’s is a protein kinase known to work inside a cell. Now, Mitri’s work shows it works outside the cell, too. To my knowledge, that’s the first time someone has shown RIPK3’s function in the plasma outside of the blood cells. From a basic science point of view, that is both very interesting and very important.” Liu goes further. From a disease point of view,
Bo Liu
“What is most striking for me is that RIPK3 is a protein kinase known to work inside a cell. Now, Mitri’s work shows it works outside the cell, too. To my knowledge, that’s the first time someone has shown RIPK3's function in the plasma outside of the blood cells”— BO LIU
The function of RIPK3
she goes on, many trauma and aneurysm patients have a higher tendency to develop thrombosis. “This phenomenon has been known for many years but there are no clear explanations. Mitri’s
Von Liebig Forum part of ONLINE opening day
THE FORUM, FEATURING abstracts from each of several content areas, will take place from 11:30 a.m. to 12:45 p.m., CDT. In addition to the Resident Research Award-winning paper, the topics include: “Explantation of infected abdominal aortic endografts: A 23-year multicenter experience”;
When: Saturday, June 20, 2020,11:52 a.m.–12:02 p.m. von Liebig Forum
A Special Thank You to Our ONLINE Supporters! (as of 5/29/20) LEADER LEVEL
By Beth Bales The Vascular Annual Meeting’s scientific sessions traditionally kick off on the Thursday of VAM—opening day of the scientific sessions—with the William J. von Liebig Forum. In keeping with that scheduling, this year’s von Liebig Forum also will be presented on the opening day of SVS ONLINE: “New Advances and Discoveries in Vascular Surgery.”
Mitri Khoury
findings could provide one potential explanation to these clinical observations. And if what he found is proven to be right, then this protein can be used as a biomarker for clinicians to screen patients with, let’s say, aneurysms, or who suffer trauma or some kind of injury, to predict how likely they may suffer from thrombotic events.” Khoury hopes to use the award as a springboard to a career as an academic vascular surgeon: “UT Southwestern gives you the option to do research years so when I decided I wanted to be an academic vascular surgeon, I decided to do research years. I applied to the University of Wisconsin, Madison, T32, and that was a huge opportunity to let me do this project.” Liu identified Khoury as a future so-called triple threat—those clinicians marked out as excellent doctors, scientists and administrators. She also highlighted the triumph the award represents for the T32 program, which she co-directs. “This NIH funding mechanism supports institutions to conduct training activities like the one we have. To my knowledge, there are only nine instances of such training funding given for vascular surgery. “We hope it means surgeon-scientists like Mitri—who are provided not only with funding for a stipend, but a research environment, a training environment—are given the foundation so that when they one day have their own labs, they have learned how to design experiments, how to conduct experiments, how to apply for funding.” The Resident Research Award only compounds the impact of the T32 training mechanism, Liu adds. As for Khoury, the award marks a milestone he has had signposted since he was an intern. “Hopefully, I get to the point where Dr. Liu is at.”
“Resection of an internal carotid artery aneurysm with extreme cranial exposure maneuvers”; “Leiomyosarcoma of the inferior vena cava: A multicenter experience”; “Predictors and sequela of burnout amongst practicing American vascular surgeons: A gender-based analysis, on behalf of the SVS Wellness Task Force”; and “Duplex ultrasound velocity criteria to determine carotid artery stenosis need to be revised: Results from CREST.” SVS president Kim Hodgson, MD, will moderate the forum, while SVS Program Committee Chair Matthew Eagleton, MD, will be digital moderator. Ellen Dillavou, MD, and Mark Farber, MD, are panelists.
Gore & Associates Janssen Pharmaceuticals, Inc. Medtronic Silk Road Medical
SUSTAINING LEVEL
Avenu Medical, Inc. BD Thompson Surgical Instruments, Inc. 3M+KCI
SUPPORTING LEVEL
Medtronic Philips North America LLC
CONTRIBUTING LEVEL
Alliance for Physician Certification & Advancement (APCA) Cook Medical COOLSHIRT SYSTEM Tactile Medical
JUNE 2020 | vascularspecialistonline.com
Vascular Connections | 5
Use of atherectomy during PVI elevated among non-vascular surgeons operating in outpatient facilities, study shows By Bryan Kay There is a higher use of atherectomy during index peripheral vascular intervention (PVI) among non-vascular surgery specialists and physicians working primarily in outpatient settings, according to a study set to be presented during a scientific session June 25.
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ead author Courtenay Holscher, MD, of Johns Hopkins Hospital in Baltimore, Maryland, who is set to present the data, et al set out to describe physician practice patterns and examine physician-level factors associated with use of atherectomy during index revascularization for patients with femoropopliteal peripheral arterial disease (PAD).
The investigation probes the established order that says atherectomy over angioplasty and/ or stenting for the treatment of symptomatic PAD is not well defined. Despite a lack of practice guidelines, the use of atherectomy has increased significantly in recent years, the authors note. Holscher et al used Medicare fee-forservice claims from calendar year 2018 to identify all beneficiaries undergoing elective first-time femoropopliteal PVI, including angioplasty, stenting, and atherectomy for claudication or chronic limb-threatening ischemia. “Patients with acute limb ischemia and physicians performing ≤10
femoropopliteal PVI during the study period were excluded,” they explain. Hierarchical logistic regression was used to evaluate patient- and physician-level characteristics associated with atherectomy, with the per-patient average and total 2018 Medicare-allowed reimbursement for index femoropopliteal PVI calculated. Of 57,481 patients included in the study, 29,855—some 51.9%— underwent atherectomy as part of their index PVI. The 1,686 physicians included in the study demonstrated a wide distribution of practice patterns in use of atherectomy, the authors found. “Adjusting for patient characteristics, newer graduates, specialists in cardiology, radiology, or cardiothoracic surgery (versus
“The 10 physicians performing the most femoropopliteal atherectomy during index PVI were reimbursed a total of $16.1 million dollars in 2018”— COURTENAY HOLSCHER ET AL
vascular surgery), physicians with a higher volume of femoropopliteal PVI, and those performing a higher percentage of services in an ambulatory surgery center or officebased laboratory were more likely to perform atherectomy during index PVI,” they write. Median per-patient Medicareallowed reimbursement was $10,639 (interquartile rate $7,241–$12,390) for physicians who performed atherectomy in ≥85% of their index PVI (quartile 4) vs. $527 (IQR 450-4,349) for those performing atherectomy in <85% of index PVI (quartiles 1-3) (P<0.001), the investigators found. Holscher et al state: “There is a wide distribution of practice patterns for use of atherectomy during index PVI, with higher utilization among non-vascular surgery specialists and physicians working primarily in outpatient settings. “There is a critical need for level one evidence about the efficacy of atherectomy compared to other available technologies, especially given the high reimbursement rate for atherectomy.” When: Thursday, June 25, 2020, 6:37p.m.–6:42 p.m. Scientific Session 4
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Burning issue: Surgeon wellness occupies central role in ONLINE agenda By Beth Bales As in the past few years, wellness and burnout—and how to mitigate them—remain topics of education and discussion at Society for Vascular Surgery meetings. THIS YEAR, WITH the world in the midst of a global pandemic, is no exception. The SVS Wellness Task Force will address the topics in two sessions of SVS ONLINE: “New Advances and Discoveries n Vascular Surgery.” The first is a presentation during the William J. von Liebig forum on June 20. “Predictors and
Save the Dates for VQI Online Sessions By Beth Bales VQI@VAM, the Vascular Quality Initiative’s annual meeting held in conjunction with the Vascular Annual Meeting, will also take a digital format in the wake of the COVID-19 pandemic. VQI, WHICH SEEKS to improve the quality, safety, effectiveness and cost of vascular health care, collects, analyzes and shares data across 14 registries. will hold two, one-hour sessions from noon to 2 p.m. Central Daylight Time Tuesdays, from June 23 through July 28.
sequela of burnout amongst practicing American vascular surgeons: A gender-based analysis,” will be held from 12:14 p.m. to 12:26 p.m. The entire forum runs from 11:30 a.m. to 12:45 p.m. CDT. The abstract follows up on a confidential survey conducted back in 2018. Lead author Laura Marie Drudi, MD, will highlight the existence of genderbased differences driving career dissatisfaction and burnout, as well as “the alarming rate of suicidal ideation amongst women,” as well as other issues affecting vascular surgeon wellness of across the spectrum of sexes. The invited session entitled “Enhancing wellness
in times of chaos” was proposed before the COVID-19 crisis hit but seems aptly titled for the times. And indeed, the pandemic is now on the agenda. Wellness Task Force chair Dawn Coleman, MD, of the University of Michigan, Ann Arbor, Michigan, will moderate the session, to be held from 7 to 8 p.m. CDT Wednesday, July 1. Co-chair Malachi Sheahan III, MD, of Louisiana State University Health Sciences Center, New Orleans, Louisiana, will be a panelist during the discussion session at the end. The topics include: “The role for surgical coaching to enhance wellness” by Jeffrey M. Smith, MD, an orthopedic surgeon in San Diego, California; “Institutional wellness initiatives” by Julie A. Freischlag, MD, CEO and dean at Wake Forest Baptist Health, Winston-Salem, North Carolina; and “Government/policy challenges and initiatives” by Margaret C. Tracci, MD, of the University of Virginia, Charlottesville, Virginia. The session will focus on expanded peer support and coaching, COVID-19 response, ongoing advocacy for SVS surgeons and possibly moving work forward into the areas of ergonomics and non-legal malpractice response.
“While we cannot replicate the live experience of the VQI Annual Meeting, we will still endeavor to provide education to help you gain a better understanding of the VQI registries in an effort to aid in the data abstraction process,” said VQI medical director Jens Eldrup-Jorgensen, MD. “We will also highlight the great accomplishments of those using VQI data for quality improvement efforts and scholarly endeavors.” Jorgensen encourages VQI members to attend the live meetings, but the events will also be recorded to permit members to view them at their own convenience. The VQI registries contain demographic, clinical, procedural and outcomes data from more than 700,000 vascular procedures performed nationwide and in Canada.
Date/Time (CDT)
Title/Topic
Presenters
6/23: 12:00-1:00 PM
VQI Nation Update
Jens Eldrup-Jorgensen, MD, and Invited Guest
6/23: 1:00-2:00 PM
VQI-DELTA Paclitaxel Device Safety Analysis
Daniel Bertges, MD and Frederic Resnic, MD Moderator: Leila Mureebe, MD
6/30: 12:00-1:00 PM
Registry Education: TEVAR
Adam Beck, MD
6/30: 1:00-2:00 PM
Registry Education: EVAR
Salvatore Scali, MD
7/7: 12:00-1:00 PM
Select Quality Improvement Abstracts:
A selection of five abstracts, taken from quality improvement abstract submissions
For more information: visit vsweb.org/VQIOnline
Earn precious CMEs and MOCs at SVS ONLINE
Adrian Fung, MD; Julie Mason, RN; Robin Acino, RN; Jennifer Landis, PA-C; and Sue Nappo, RN 7/7: 1:00 to 2:00 PM
Using the VQI to Monitor Compliance with Clinical Practice Guidelines
Jens Eldrup-Jorgensen, MD Moderator: Leila Mureebe, MD
7/14: 12:00-1:00 PM
Registry Education: PVI
Daniel Bertges, MD
7/14: 1:00-2:00 PM
Registry Education: TCAR/CAS/CEA
Mahmoud Malas, MD
7/21: 12:00-1:00 PM
Value of VISION and claims-matched data in the VQI – EVAR
Sarah Deery, MD, and Philip Goodney, MD
7/21: 1:00-2:00 PM
Rapid-Fire Research Session
A selection of seven abstracts based on VQI data
By Beth Bales
Moderator: Grace Wang, MD Scott Levin, MD (2) Craig Brown, MD Sarah Severance, MD Luke Stewart, MD Cali Johnson, MD, EdD Patrick Beyer, MD
Physician registrants: get a boost on collecting required continuing medical education (CME) and Maintenance of Certification (MOC) Self-Assessment credits during SVS ONLINE: “New Advances and Discoveries in Vascular Surgery.” THE SOCIETY FOR Vascular Surgery is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. SVS designates this live activity for 23.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. As of May 29, a total of 13 MOC credits also was available. Credits must be claimed by Dec. 31, 2020.
7/28: 12:00-1:00 PM
Registry Education: Venous Stent
Marc Passman, MD
7/28: 1:00-2:00 PM
Registry Education: Hemodialysis
Theodore Yuo, MD
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Endovascular aortic arch repair with three-vessel inner branches is safe, investigators find By Bryan Kay
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otal endovascular aortic arch repair for aneurysms and chronic dissections using three-vessel inner branch stent-grafts is technically feasible and safe, a multicenter global early feasibility study finds. “Mortality and stroke rates compare favorably to reported outcomes of total open surgical arch replacement, particularly among higher risk patients who had prior median sternotomies and ascending aortic repairs,” Emanuel R. Tenorio, MD, aortic research fellow at the Mayo Clinic in Rochester, Minnesota, et al report. Tenorio will deliver the findings in a scientific session on June 30. The research team had sought to evaluate
Study: Decreased complication among EVAR conversion patients anticipated when managed at highvolume aortic centers By Bryan Kay
ENDOVASCULAR AORTIC aneurysm repair (EVAR) conversion to open aortic repair (OAR) is now an increasingly common indication and associated with greater operative complexity. However, “decreased complication risk and comparable survival can be anticipated when patients are managed at high-volume aortic referral centers,” a new study to be presented during a scientific session on June 25 will show. Presenting author Christopher Jacobs, MD, of the University of Florida in Gainesville, Florida, is set to present data from an 18-year retrospective review of all open repair procedures performed at a single academic medical center. Jacobs et al conducted the study against the backdrop of what they
outcomes of endovascular repair using the threevessel inner branch method. They reviewed clinical data and outcomes of consecutive patients treated by way of total endovascular aortic arch repair at eight academic centers over from 2016–2019. They explain: “All patients received patientspecific stent designs with two antegrade and one retrograde inner branch, which was used to incorporate the innominate (IA), left common carotid (LCCA) and left subclavian arteries (LSA). The antegrade inner branches were accessed via axillary or carotid artery access. “A preloaded catheter was used for access to the retrograde LSA branch via femoral approach. End-points were technical success, mortality, major adverse events (MAEs), any stroke (minor or major) or transient ischemic attack (TIA),
“Mortality and stroke rates compare favorably to reported outcomes of total open surgical arch replacement, particularly among higher risk patients who had prior median sternotomies and ascending aortic repairs”— EMANUEL R. TENORIO ET AL
described as a paucity of data “highlighting the evolution of periprocedural results surrounding EVAR conversion and changes in practice patterns, especially for referral centers that increasingly manage EVAR failures due to care regionalization.” They set out to perform a temporal analysis of their center’s experience with conversion to open repair and describe changes in patient selection, operative details and outcomes. The data deployed was drawn from between the period 2002–2019. EVAR conversion patients (184) were categorized into three eras: 2002–2009 (21), 2010–2014 (67) and 2015–2019 (96). The study detected a significant increase in EVAR conversion as an indication for OAR (p-trend<0.001). The authors further concluded: “In an era of diminishing OAR volumes, these findings underscore growing concerns surrounding competency and proficiency in aortic surgery.” This further emphasized the need to develop comprehensive specialtywide and procedure-specific initiatives to optimize appropriate and balanced use of EVAR and OAR in the management of AAAs [abdominal aortic aneurysms] nationally, the investigators added. When: Thursday, June 25, 2020, 1:10 p.m.–1:15 p.m. Scientific Session 3
secondary interventions, target vessel patency, target vessel instability, aneurysm-related mortality and patient survival.” A total of 39 patients—31 of them male (79%) and with a mean age of 70 (±7)—were treated for 14 (36%) degenerative and 25 (64%) chronic post-dissection arch aneurysms. Clinical Arch repair characteristics included American Society of Anesthesiologist (ASA) classification >3 in 37 patients (95%) and prior median sternotomy for ascending aortic repair in 33 patients (85%), Tenorio et al find. Technical success rate was 100%, the investigators say. “This multicenter global experience demonstrates the technical feasibility and safety of total endovascular aortic arch repair for aneurysms and chronic dissections using three-vessel inner branch stent-grafts,” the authors conclude. When: Tuesday, June 30, 2020, 6:30 p.m.–6:42 p.m. Scientific Session 6
CEA found to significantly improve neurocognitive function 30 days after procedure By Bryan Kay Revascularization by way of carotid artery endarterectomy (CEA) is linked to significant improvements in neurocognitive function a month postprocedure across multiple domains, a July 1 scientific session will hear.
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urthermore, presenting author Natalie Sridharan, MD, assistant professor of surgery at the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania, will tell attendees about how statin use may provide further protection
“Neurocognitive improvement following CEA may justify reconsideration of the role of carotid revascularization in asymptomatic patients”— NATALIE SRIDHARAN ET AL
and that longer-term follow-up is needed “to see the magnitude and durability of these cognitive improvements.” Sridharan et al made the discoveries during an interim noncomparative analysis of a cohort enrolled in an institutional randomized trial looking at the role of remote ischemic preconditioning for CEA. The study was set against the backdrop of the rarity of stroke following CEA but the much more common occurrence of magnetic resonance imaging showing “silent” microinfarctions after surgery. Some 80 patients with a mean age of 71.3 (± 7.1) were enrolled, the authors note. In summing up their findings, they write: “Neurocognitive improvement following CEA may justify reconsideration of the role of carotid revascularization in asymptomatic patients.” When: Wednesday, July 1, 2020, 6:39 p.m.–6:51 p.m. Scientific Session 7
JUNE 2020 | vascularspecialistonline.com
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New paradigm in arteriovenous grafts opens up possibility of novel cure for diabetes, researchers find By Bryan Kay
A novel twist to arteriovenous graft platforms—traditionally the preserve of hemodialysis—has the ability to open up a new paradigm of treatment across a host of metabolic disorders like diabetes, a study to be presented at a scientific session on June 27 will demonstrate. FOR INITIAL IN vivo trials, of Medicine in St. Louis, who will performed on adult pigs, present data from the study during researchers constructed a the scientific session. “We used an multilayered arteriovenous graft age-old idea where arteriovenous with specific biomaterials made of grafts, typically used for hemodialysis polytetrafluoroethylene (PTFE). The purposes, can be re-appropriated multilayered graft, modified for the purpose of cellular in order that it could be transplantation,” he tells implanted with pancreatic Vascular Connections. “We beta cells, would then constructed a multilayered function in vivo, releasing arteriovenous graft with insulin inside the implanted specifications that allow for host. The researchers would easy cellular implantation. then be able to demonstrate For our proof of concept the treatment of diabetes experiments, we implanted without ex vivo insulin. Mohamed Zayed insulin-producing beta cells in The investigators were the graft to determine if this able to demonstrate that their novel can be a novel platform for treatment arteriovenous graft platform can be of diabetes.” used—sans immunosuppression— The results of the study, Zayed in a large animal with good beta goes on, showed that “porous cell survival, observed Mohamed layers in the arteriovenous graft Zayed, MD, an assistant professor allowed for efficient diffusion of at Washington University School glucose and insulin and had good
Novel cure for diabetes beckons
biocompatibility. In vivo, we observed successfully surgical implantation of the arteriovenous graft, 100% survival of implanted pigs, and good graft patency as monitored by serial ultrasound.” Zayed, also a vascular surgeon at the St Louis Veterans Affairs Medical Center, set out to develop an alternative to ex vivo insulin administration in patients with diabetes who don’t have a functional capacity to produce enough insulin. His quest to produce an alternative through cell transplantation, he explains, exists in a field that has been stagnating “due to the heavy reliance on immunosuppression in patients that require pancreatic or islet cell transplants.” But Zayed et al made
Navigate SVS ONLINE with planner
Register for SVS ONLINE
By Beth Bales
The perfect match for an online meeting? An online planner. And it makes navigating SVS ONLINE a snap. IT FOLLOWS THE basic outline of planners from the past few iterations of the Vascular Annual Meeting (VAM), with left-side navigation links for the program itself, educational credits, faculty, registration, the accompanying sessions from the Vascular Quality Initiative and the Society for Vascular Nursing, sponsors, exhibitors, as well as a whole host of other functions. Users may find the full schedule and then browse by date or sessions. Each item will reveal more information on the session plus,
where applicable, the corresponding abstracts and other supporting information. The online planner functions as a useful aid in order to mark out specific sessions of interest, and includes the ability to create a list of “favorites.” Attendees can also claim educational credits and take selfassessment exams immediately after applicable sessions. Find the planner at: vsweb.org/Planner2020.
Be a part of everything SVS ONLINE has to offer. Register at any time at vsweb.org/SVS-ONLINE
Registration Fees: SVS ONLINE
strides on immunosuppression. “What’s remarkable about this study is that, with the current designs we’ve iterated, the host does not need any immunosuppression,” Zayed says. “So, without having to administer any immunosuppression, we’re able to maintain high cell survival and sustained insulin-production from the cells placed in the arteriovenous graft. And this has been confirmed in a large animal model. Our proof of concept has been successful, and we hope to translate this eventually into humans who need a host of these types of metabolic therapies.” When: Saturday, June 27, 2020, 9:32 a.m.–9:42 a.m. Scientific Session 5
Society for Vascular Surgery Member (includes Active, Distinguished Fellow, Graduated Candidates, Honorary, International, Associate) $75 SVS Candidate Member-in-Training (includes Medical Students, General Surgery Residents and Vascular Residents and Fellows) $0 SVS Affiliate Member (includes PAs, Nurses, Nurse Practitioners, Technologists and SVN Active members) $75 Non-Member Physicians and Researchers $200 Non-Member General Surgery Resident/ Student/SVN Associate and Student* $100
* Fees will be assigned automatically based on your membership status. Be sure that your dues are current in order to obtain the member pricing. Non-member medical students and general surgery residents may qualify for the SVS Candidate-in-training $0 registration rate by applying for complimentary membership with the SVS. Visit vsweb.org/SVSDues to pay dues. This process must be completed prior to the start of registration in order to qualify.